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Coronavirus disease (COVID-19) pandemic is affecting the world unevenly. One of the highest numbers of cases were recorded in the most polluted regions worldwide. The risk factors for severe COVID-19 include diabetes, cardiovascular, and respiratory diseases. It has been known that the same disease might be worsened by chronic exposure to air pollution. The study aimed to determine whether long-term average exposure to air pollution is associated with an increased risk of COVID-19 cases and deaths in Poland. The cumulative number of COVID-19 cases and deaths for each voivodeship (the main administrative level of jurisdictions) in Poland were collected from March 4, 2020, to May 15, 2020. Based on the official data published by Chief Inspectorate of Environmental Protection voivodeship-level long-term exposure to main air pollution: PM2.5, PM10, NO2, SO2, O3 (averaged from 2013 to 2018) was established. There were statistically significant correlation between COVID-19 cases (per 100,000 population) and annual average concentration of PM2.5 (R2 = 0.367, p = 0.016), PM10 (R2 = 0.415, p = 0.009), SO2 (R2 = 0.489, p = 0.003), and O3 (R2 = 0.537, p = 0.0018). Moreover, COVID-19 deaths (per 100,000 population) were associated with annual average concentration of PM2.5 (R2 = 0.290, p = 0.038), NO2 (R2 = 0.319, p = 0.028), O3 (R2 = 0.452, p = 0.006). The long-term exposure to air pollution, especially PM2.5, PM10, SO2, NO2, O3 seems to play an essential role in COVID-19 prevalence and mortality. Long-term exposure to air pollution might increase the susceptibility to the infection, exacerbates the severity of SARS-CoV-2 infections, and worsens the patients’ prognosis. The study provides generalized and possible universal trends. Detailed analyzes of the phenomenon dedicated to a given region require taking into account data on comorbidities and socioeconomic variables as well as information about the long-term exposure to air pollution and COVID-19 cases and deaths at smaller administrative level of jurisdictions (community or at least district level).

Introduction The presence of lower urinary tract symptoms (LUTS) might be linked with elevated cardiovascular risk. There is a lack of data showing the prevalence of LUTS in the population of patients with cardiovascular diseases. The current study aimed to determine the prevalence of LUTS in patients hospitalized due to a cardiovascular disease. Material and methods Patients hospitalized in a tertiary cardiology department due to a primary diagnosis of cardiovascular disease (including coronary artery disease, heart failure and arrhythmia) were included in the study. All patients were screened for LUTS and assessed using the International Prostate Symptoms Score (IPSS). Results From 166 patients (age 62.8 ±12.1 years), moderate to severe LUTS was diagnosed in 62 patients (37.3%). Patients with LUTS were significantly older, but there were no other factors associated with LUTS. When we divided patients according to LUTS severity, we saw an increasing prevalence of arterial hypertension (69.5% vs 72.9% vs 100%), diabetes mellitus (29.5% vs 33.3% vs 38.5%), coronary artery disease (68.6% vs 72.9% vs 92.3%), but the observations were not statistically significant. Patients with coronary artery disease had significantly higher severity of LUTS compared to patients with arrhythmia or heart failure (mean IPSS 8.88 vs 5.6 vs 5.5, p = 0.004). Conclusions The prevalence of LUTS in patients with cardiovascular diseases is high, affecting 37.3% of the studied population. Patients with coronary artery disease have significantly higher severity of LUTS compared to other cardiovascular diseases.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), spreads rapidly and has been announced a pandemic by the World Health Organization (WHO). COVID-19 especially affects cardiovascular system, mostly by leading to the dysfunction of endothelium and its consequences. On the other hand, patients with a history of chronic disease are believed to have a more severe course of COVID-19. Furthermore, apart from an undoubted influence on morbidity and mortality, COVID-19 results in changes in many aspects of human life. It is worth noting that pandemic will also affect people who did not suffer from disease. Nevertheless, due to constantly elevated stress level, COVID-19 may have influence on mental health. Paradoxically, in dealing with stress and COVID-related problems, faith and religiosity can play a leading role. In this review, attention was paid not only to possible cardiac complications of infection but also to the impact of the pandemic on psychological and spiritual effects of the pandemic.

Lower urinary tract symptoms (LUTS) are etiologically heterogeneous group of clinical symptoms, which are related to disorders of the lower urinary tract (bladder, prostate and urethra). LUTS are common break down into two symptoms groups: voiding (obstructive) symptoms or storage (irritative) symptoms. Patients may have mainly voiding symptoms, storage symptoms or a combination of both. The occurrence of LUTS is not limited to specific disease despite the frequent association of these symptoms with the bladder outlet obstruction. Furthermore, they can be an indicator of structural and functional abnormalities of the urinary tract, as well as the indicator of many other non-urological diseases ( e.g. chronic kidney disease, cardiovascular disease, disorders of the central nervous system and endocrine system). In many cases, LUTS are consequence of systemic changes that are caused by cardiovascular risk factors such as diabetes, hyperlipidemia or hypertension. This paper discusses the relationship between the occurrence of LUTS and the cardiovascular disease and the potential clinical implications regarding the management of the patients.

Visfatin is an adipokine produced by visceral fat tissue and takes part in fibrosis and inflammatory response. In the heart muscle, it is connected with the progression of atherosclerosis. Currently, there is no data on how visfatin affects atrial fibrillation (AF) onset. The study aimed to establish if baseline visfatin levels are connected with the risk of arrhythmia recurrence after AF ablation. In this prospective, long-term, observational study, we enrolled 290 consecutive patients admitted for AF ablation. All patients were screened for cardiovascular risk factors and had blood serum taken to measure visfatin concentrations before the ablation procedure. The end point of the study was a recurrence of the AF, defined as at least one AF episode of at any moment during the follow-up period. The screening included AF of at least 30 second duration assessed with electrocardiogram (ECG) monitoring, including 24-hour ECG Holter monitoring, implantable pacemakers, implantable defibrillators, or subcutaneous ECG monitoring devices. After excluding patients disqualified from the procedure the study population consisted of 236 patients, mean age 57.8 years (64.8% male). Mean body mass index in the population was 29.6 ± 4.8 kg/m2 and arterial hypertension was highly prevalent (73.3% of patients). In 129 (54.7%) cases we observed recurrence of AF during the follow-up period. Patients with AF recurrence had higher visfatin levels (1.7 ± 2.4 vs 2.1 ± 1.9 ng/ml; p

Background. Atrial fibrillation (AF) remains one of the major causes of cardiovascular morbidity worldwide. Left atrial enlargement (LAE) is a common risk factor of AF. Left atrial enlargement is also connected with a higher prevalence of heart failure in AF patients. The aim of this study was to assess the prevalence of LAE in Polish patients with AF. Material and methods. Transthoracic echocardiography was performed in consecutive AF patients hospitalized in the Department of Heart Diseases. We assessed LAE using a two-dimensional method. Left atrial (LA) size was classified into the 4 categories: normal (LAE values < 39 mm in women and < 41 mm in men), mildly enlarged (39–42 mm in women and 41–46 mm in men), moderately enlarged (43–46 mm in women and 47–51 mm in men), and severely enlarged (≥ 47 mm in women and ≥ 52 mm in men). Results. We analyzed 113 individuals with AF (mean age 77.2 ± 9.8 years; 37.2% men). Of these, 71 (62.8%) patients had LAE (age 77.6 ± 9.9 years; 36.6% men). LA was mildly enlarged (39–42 mm in women and 41–46 mm in men) in 20 (28.2%) patients, moderately enlarged (43–46 mm in women and 47–51 mm in men) was observed in 30 (42.3%), and severely enlarged (≥ 47 mm in women and ≥ 52 mm in men) in 21 (29.6%) patients. The incidence of heart failure was significantly higher in AF patients with LAE [39 (54.9%) compared to the patients without LAE — 12 (28.6%) p = 0.01]. Conclusions. In patients with AF, LAE was highly prevalent. Patients with AF and LAE have more often HF compared to AF patients without LAE.

Background The presence of obstructive sleep apnea (OSA), a novel cardiovascular risk factor, contributes to the development of peripheral arterial diseases (PAD). There is a lack of data showing how often these diseases coexist. Aims The aim of the study was to determine the prevalence of OSA in the population of patients with PAD. Methods Patients previously qualified for the first revascularization due to PAD were included in the study. All patients underwent an overnight sleep study to detect OSA. Diagnosis of OSA was made when the apnea–hypopnea index (AHI) was ≥5 per hour. Results From 141 patients (60% men, age 69.6 ± 9.5 years), OSA was diagnosed in 68 patients (48%). OSA occurred in mild form (5 ≤ AHI < 15/h) in 39 cases (28%), in moderate form (15 ≤ AHI < 30/h) in 21 cases (15%), and in severe form (AHI ≥ 30/h) in 8 cases (6%). Patients without OSA had significantly lower body mass index (BMI; 26.9 ± 5.5 vs. 27.7 ± 5.3 kg/m2, p = 0.01) and lower hip circumference (97.4 ± 11.7 vs. 98.7 ± 7.4, p = 0.04). There were no differences in the distribution of other investigated cardiovascular risk factors and diseases between these groups. There were no significant differences in OSA distribution or its severity between patients with lower extremity artery disease and carotid artery disease. Conclusions The prevalence of OSA in patients with PAD is very high, affecting nearly half of the studied population.

Smoking, especially of cigarettes, is one of the best-recognised and most widely studied risk factors for cardiovascular disease and death. Despite the availability of many methods of counteracting tobacco addiction, their effective- ness is still insufficient. An alternative to smoking cigarettes could be tobacco products based on heating tobacco (‘heat-not-burn’), the use of which may be associated with a lower cardiovascular risk. this article presents a summary of the current state of knowledge and the recommendations of Polish experts regarding the safety of these products.

Non-vitamin K oral anticoagulants (NOAC) are drugs that relatively recently have been introduced into clinical practice, but have proven to be extremely effective and very willingly and widely used. The efficacy of NOAC, including rivaroxaban, in the prevention of stroke and thromboembolic events in groups of patients with multiple indications for antithrombotic therapy is well known. Rivaroxaban not only has a beneficial effect on thromboembolic processes, but probably also causes a number of pleiotropic actions that combine with the reduction of blood vessel damage associated with the presence of cardiovascular risk factors and has the potential to inhibit the development of atherosclerotic lesions. The following study shows the latest knowledge about new potential indications for the use of the drug.

Cardiovascular diseases are the leading cause of hospitalization and mortality across the world. In 2013, the estimated number of deaths from cardiovascular diseases exceeded 17 million, accounting for 31.5% of all deaths globally, i.e. twice the number of all cancer-related deaths The article explores the correlation between selected dermatological diseases and an elevated risk of cardiovascular events. In addition, cutaneous manifestations of cardiovascular diseases which are important in the physician’s practice, and therapeutic dilemmas involved in the coexistence of cardiac and dermatological diseases, are discussed.

2MACE is a risk assessment score designed to stratify cardiovascular risk in patients with atrial fibrillation (AF). Early detection of increased cardiovascular risk is of vital importance in this population, as it helps reduce mortality and morbidity rates.This study aimed to assess the utility of the 2MACE score in predicting long‑term mortality in patients with AF.This was a post hoc analysis of a prospective observational cohort study including consecutive patients with nonvalvular AF, who were followed for a median duration of 81 months.The final analysis included 1351 patients (men, 53.1%; median [interquartile range] age, 71 [62-80] years). During the follow‑up, 142 patients (10.5%) died. Deceased patients were more often classified as high risk according to the 2MACE score than survivors (80.3% vs 53.2%; P0.0001). The receiver operator characteristic curve analysis demonstrated that the 2MACE score had a good predictive value for long‑ term all cause mortality (area under the curve, 0.73; 95% CI, 0.69-0.78). The mortality rate was significantly increased in patients with a 2MACE score of 3 or higher (hazard ratio, 3.40; 95% CI, 2.33-5.49).The 2MACE score is a good predictor of long‑ term all cause mortality in patients with AF. A progressive increase in the mortality rate was observed with an increasing 2MACE score.

INTRODUCTION 2MACE is a risk assessment score designed to stratify cardiovascular risk in patients with atrial fibrillation (AF). Early detection of increased cardiovascular risk is of vital importance in this population, as it helps reduce mortality and morbidity rates. OBJECTIVES This study aimed to assess the utility of the 2MACE score in predicting long‑term mortality in patients with AF. PATIENTS AND METHODS This was a post hoc analysis of a prospective observational cohort study including consecutive patients with nonvalvular AF, who were followed for a median duration of 81 months. RESULTS The final analysis included 1351 patients (men, 53.1%; median [interquartile range] age, 71 [62-80] years). During the follow‑up, 142 patients (10.5%) died. Deceased patients were more often classified as high risk according to the 2MACE score than survivors (80.3% vs 53.2%; P

Serotonin plays an important role in regulating the cardiovascular system. Drugs widely used in the treatment of depression, migraine, Parkinson’s disease or obesity affect the serotonergic system. The use of these compounds causes both acute and chronic effects, depending on the type of activated 5-HT receptor and its location. An acute cardiac response to 5-HT, known as Bezold-Jarisch reflex, leads to bradycardia and hypotension. The chronic contribution of serotonin may be associated with fibrosis and cardiac valve degeneration. This article analyses the impact of 5-HT receptors activation on the cardiovascular system and describes side effects of this activation and new therapies targeting this system.

The aging process does not occur in the same way for all patients. The pace of this process, both physical and mental, is very different. The quality of life of an elderly patient depends on many factors, including lifestyle, genetic predisposition and appropriate medical care. The quality of health care depends, among other things, on how quickly and, whether or not, the doctor sees correctly signs of premature or „abnormal” aging. To facilitate this, a set of symptoms was identified, the occurrence of which should alert the doctor due to the relationship with increased mortality. In the English-language literature, this group is called frailty syndrome. In the Polish literature, the most widely used description of this phenomenon is probably zespol kruchości . The aim of this paper was to present the importance of this syndrome in clinical practice.

Background: Periodontal disease is a chronic disease causing an inflammatory process that affects various organs and is as­sociated with an increased risk of many diseases, including bone and cardiovascular disease. Aim: The aim of this study was to establish the prevalence of periodontal disease in continuous patients scheduled for hip or knee replacement surgery. Methods: The study was a prospective, epidemiological analysis performed in consecutive patients scheduled for total joint (hip or knee) replacement surgery. Patients enrolled into the study were screened for classical risk factors and had a dental evaluation performed for the diagnosis of periodontal disease. Results: The study population consisted of 228 patients. A total of 137 (60.1%) patients were scheduled for a hip replace­ment surgery, while 91 (39.9%) had a knee replacement. The mean age of the study population was 66.8 ± 12.2 years, and 83 (36.4%) patients were male. A clinically significant disease was present in 65 (28.5%) cases, while all (100%) of the patients had at least minimal signs of periodontal disease. In patients with periodontal disease the percentage of tartar involvement of the teeth was 33.1 ± 26.8%, mean dental plaque coverage was 48.1 ± 29.8%, and bleeding occurred at a rate of 35.4 ± 29%. As for the hygiene level, it was generally poor in the majority of patients with periodontal disease. No differences in terms of baseline risk factors were present between patients with and without periodontal disease. Conclusions: In conclusion, periodontal diseases are highly prevalent in patients undergoing hip and/or knee replacement surgery. The presence of the periodontal disease is possibly associated with a worse prognosis and should be treated.

Cardiovascular risk assessment in clinical practice isessential. It affects treatment methods of cardiovascular diseases in patients. Recommended tools such as POL-SCORE do not take into account the clinical picture of all the patients. The clinical case shows that the use of nonclassical elements of risk factors in clinical practice changes the scheme of action undertaken so far.

Professional drivers are a group exposed to many cardiovascular risk factors. Nonsystematic working hours, stress, low physical activity, and unhealthy dietary habits are common among professional drivers. These translate into high risk of cardiovascular disease. The aim of the current analysis was to establish the prevalence of arterial hypertension in a group of continuous professional drivers. The RACER (Risk of Adverse Cardiovascular Events among professional dRivers in Poland) study is a prospective study focused on assessing cardiovascular risk factors in professional drivers. Patients included in the study were screened for the classical and nonclassical cardiovascular risk factors and had an ambulatory blood pressure monitoring (ABPM) performed. Of the RACER study population, 144 drivers were included into the RACER-ABPM study. Of this group 135 (95.7%) were male at mean age of 50.2 ± 9.3 years, with mean body mass index of 32.3 ± 3.0 kg/m2. In 21.3% of patients, family history of cardiovascular disease was noted, 28.1% were current smokers, and 2.9% had diabetes mellitus. Arterial hypertension was previously diagnosed in 39 patients (27.9%). In ABPM, the mean 24-hour blood pressure (BP) values were 130.3 ± 14.3 and 80.9 ± 9.9 for systolic and diastolic BP, respectively, and 46.1% of patients could be categorized as dippers. Based on the ABPM results, arterial hypertension was diagnosed in 104 of patients (73.8%). Patients with hypertension tend to be more often male and have a family history of cardiovascular disease. In conclusion, arterial hypertension is highly prevalent in professional drivers. Also abnormal day-to-night BP value patterns are often seen in this group.

In many cases, atrial fibrillation (AF) is associated with a history of cardiac inflammation. One of the potential pathogens responsible for atrial inflammation might be Borrelia burgdorferi - a pathogen involved in Lyme carditis. This study aimed to assess whether the serological history of Borrelia infection was associated with the risk of AF. The study included 113 AF patients and 109 patients in sinus rhythm. All patients underwent a clinical evaluation, echocardiography and had their blood taken for the assessment of anti-Borrelia IgG antibodies. Patients with AF compared with the non-AF group had more often serological signs of Borrelia infection (34.5% vs 6.4%; p

We present a case of acute myocardial infarction secondary to arterial thromboembolism in a 25-year-old man with systemic lupus erythematosus and antiphospholipid syndrome (APS). To our knowledge, based on the literature review, this patient is the youngest one with the acute coronary syndrome as a complication of APS. Acute myocardial infarction secondary to arterial thromboembolism is a rare presentation of APS. There are different recommended anticoagulation strategies in APS patients according to the presence of thrombosis of arterial or venous origin. Potential difficulties in the treatment may occur based on the clinical scenarios. A large number of APS patients require lifelong oral anticoagulation with vitamin K antagonists. Some non-vitamin K oral anticoagulants are being studied as drugs potentially useful in APS treatment. The recent studies suggest the role of aGAPSS score in assessing the risk of a recurrent thrombotic event as well as acute myocardial infarction in APS patients.

Introduction The relationship between cardiovascular disease (CVD) and lower urinary tract symptoms (LUTS) is well established. A healthy lifestyle with a good quality diet and regular physical activity is important for reducing the severity of LUTS. Material and methods A literature search was performed on the subject of association between LUTS and cardiovascular risk. Results The recent data indicates that therapy for cardiovascular risk reduction might also reduce the severity of LUTS (e.g. statins reduce the risk of benign prostatic hyperplasia [BPH] and slow down the progression of LUTS in patients with hyperlipidaemia). Hypertensive patients treated with angiotensin II receptor blockers have a lower severity of LUTS. This paper shortly discusses the relationship between the occurrence of LUTS and CVD and the potential clinical implications regarding the management of the patients. Conclusions Patients with lower urinary tract symptoms require a holistic approach and cooperation of a urologist and cardiologist to diagnose concomitant cardiovascular diseases as early as possible and implement appropriate treatment. Antihypertensive, antithrombotic, hypolipemic therapies and healthy lifestyles reduce not only cardiovascular mortality, but also might reduce the severity of LUTS.

Overweight and obesity have become a dangerous disease requiring multiple interventions, treatment and preventions. In women of reproductive age, obesity is one of the most common medical conditions. Among others, obese state is characterized by low-grade systemic inflammation and enhanced oxidative stress. Increased maternal body mass index might amplify inflammation and reactive oxygen species production, which is associated with unfavourable clinical outcomes that affect both mother and child. Intrauterine growth retardation, preeclampsia, or gestational diabetes mellitus are examples of the hampered maternal and foetoplacental unit interactions. Visfatin is the obesity-related adipokine produced mainly by the visceral adipose tissue. Visfatin affects glucose homeostasis, as well as the regulation of genes related to oxidative stress and inflammatory response. Here, we review visfatin interactions in pregnancy-related disorders linked to obesity. We highlight the possible predictive and prognostic value of visfatin in diagnostic strategies on gravidas with obesity.

Background Assessment of thromboembolic risk is crucial in choosing appropriate treatment in atrial fibrillation (AF). Current guidelines recommend basing the decision on the CHA2DS2-VASc score. However, the score is based only on clinical parameters and therefore its relationship with laboratory-assessed coagulation status might not always be objective. Objectives The aim of this study was to assess if the CHA2DS2-VASc score is associated with blood parameters in AF patients. Material and methods Patients with continuous AF prequalified for catheter ablation were enrolled into the study and had CHA2DS2-VASc calculated and blood taken for coagulation parameters. Results The study population comprised of 266 patients (65.0% males; age 57.6 ±10.1 years). Patients were divided into those with CHA2DS2-VASc score 0, and those with ≥1 points, respectively requiring and not requiring anticoagulation treatment. The group with CHA2DS2-VASc = 0 (12% of patients) compared to those with CHA2DS2-VASc ≥ 1 had a significantly lower fibrinogen concentration (285.6 ±82.0 vs 322.6 ±76.4 mg/dL; p = 0.02). Partial thromboplastin time was not significantly different between groups (p > 0.05). Differences were noticed in parameters concerning red blood cells. Lower risk patients had a lower red blood cell count (4.9 ±0.4 vs 5.1 ±6.0 106/μL); p = 0.03), higher hemoglobin concentration (14.9 ±1.0 vs 14.3 ±1.4 g/dL; p = 0.04), and higher hematocrit (43.5 ±2.6 vs 41.7 ±4.7%; p = 0.001). It was observed that along with the increase in CHA2DS2-VASc score mean fibrinogen concentration increased (p-value for trend = 0.04). Conclusions In summary, a higher CHA2DS2-VASc score is independently associated with an increase in fibrinogen concentration. Further research is needed to assess the value of fibrinogen in thromboembolic risk assessment.

Wstep: Ocena ryzyka ma szczegolne znaczenie u pacjentow poddawanych interwencjom chirurgicznym. Zabiegi ortopedyczne, w szczegolności calkowita alloplastyka stawow, są operacjami związanymi z wysokim ryzykiem okolooperacyjnym, jak rowniez jednym z najwyzszych odsetkow powiklan. Cel: Celem niniejszej pracy bylo określenie czestości wystepowania klasycznych i nieklasycznych czynnikow ryzyka sercowo-naczyniowego u pacjentow poddawanych calkowitej alloplastyce stawu biodrowego lub kolanowego. Metody: CRASH-JOINT ( Cardiovascular Risk Assessment ScHeme in JOINT alloplasty ) bylo prospektywnym badaniem epidemio­logicznym przeprowadzonym u pacjentow poddawanych operacji calkowitej alloplastyki stawu biodrowego lub kolanowego. Chorzy wlączeni do projektu byli badani pod kątem klasycznych i nieklasycznych czynnikow ryzyka sercowo-naczyniowego i przeprowadzono u nich calodobowe pomiary wartości ciśnienia tetniczego. Wyniki: Do badania wlączono 98 osob. Podczas wstepnej ewaluacji 8 pacjentow zostalo wykluczonych z badania i wylączonych z zabiegu, w wiekszości z powodu przyczyn sercowych. U 65 chorych przeprowadzono wymiane stawu biodrowego i 25 stawu kolanowego (średni wiek 63,7 ± 12,2 roku, 62,2% kobiet). Wśrod klasycznych czynnikow ryzyka zwracalo uwage 50 (55,6%) osob z rozpoznaniem nadciśnienia tetniczego w przeszlości, 10 (11,1%) pacjentow mialo cukrzyce, 2 (2,2%) wystąpil zawal serca w przeszlości, a u 24 (26,7%) w wywiadzie rodzinnym zanotowano choroby sercowo-naczyniowe. Średni wskaźnik masy ciala (BMI) wynosil 28,0 ± 5,1 kg/m 2 , nadwage zaobserwowano u 39 (43,3%) pacjentow, a u 28 (31,1%) — otylośc. Pacjenci poddawani wymianie stawu biodrowego byli istotnie mlodsi (61,8 ± 12,6 vs . 68,5 ± 10,0 lat; p = 0,02), byli cześ­ciej palaczami tytoniu (24,6% vs . 4,0%; p = 0,03), mieli istotnie nizsze BMI (26,8 ± 4,5 vs . 31,2 ± 5,3 kg/m 2 , p < 0,0001) i rzadziej byli otyli (18,5% vs . 64,0%, p < 0,0001). Nie stwierdzono istotnych roznic miedzy pacjentami zakwalifikowanymi do operacji pierwotnej i ponownej reoperacji. Wnioski: Badanie wykazalo, ze czynniki ryzyka sercowo-naczyniowego u osob poddawanych calkowitej alloplastyce stawu biodrowego lub kolanowego są obecne cześciej niz w populacji ogolnej, co moze potencjalnie przyczynic sie do podwyzszonego ryzyka rozwoju powiklan okolooperacyjnych.

Background Risk stratification in patients with atrial fibrillation (AF) is critically important because this group is at high risk of mortality and morbidity. One of the comorbidities potentially affecting thromboembolic and total cardiovascular risk is obstructive sleep apnea (OSA). The aim of this study was to determine whether or not patients with atrial fibrillation and concomitant obstructive sleep apnea have a higher predicted cardiovascular risk than those without sleep-disordered breathing. Methods The study was designed to be a cross-sectional observational study. Consecutive patients with primary diagnosis of AF who qualified for first-ever catheter ablation between 2011 and 2013 were enrolled. All patients had an overnight polysomnography performed for the diagnosis of OSA and calculation of a 2MACE score—a cardiovascular risk assessment score for AF. Results We studied 211 AF patients (mean age 57.1 ± 10.2 years, 62.6% males). OSA with apnea-hypopnea index (AHI) ≥15/h was found in 48 patients (22.7%). Cardiovascular disease and risk factors were as follows: 8 (3.8%) patients had congestive heart failure, 27 (12.8%) diabetes, 16 (7.6%) history of stroke or thromboembolic disease, 194 (91.9%) arterial hypertension, 24 (11.4%) vascular disease, and 31 (14.7%) were current smokers. A significantly higher percentage of patients with OSA was at high risk of cardiovascular disease (29.2 vs. 8.1%; p

Bisoprolol is one of the most widely used beta-blockers characterised by cardioselectivity, and it has no intrinsic sympathomimetic activity. It is commonly used in the treatment of coronary heart disease and heart failure.The aim of study was to assess the bioequivalence of the film-coated tablets containing 2.5 mg of bisoprolol (Bisocard® - the medicinal product) to the original medicinal product (Concor Cor 2.5® - the reference).A randomised, open-label, two-period, crossover, single-dose, relative bioavailability study was conducted in fasted healthy Caucasian volunteers. A single 10-mg oral dose (four tablets of 2.5 mg) of the test or reference product was followed by a 14-day wash-out period, after which the subjects received the alternative product. Blood was sampled within a period of 60 h post administration in pre-specified time points. Bisoprolol concentrations were determined by a validated LC-MS/MS method. The products were considered bioequivalent if the 90% confidence interval (CI) of the log-transformed geometric mean ratios (test vs. reference) for AUC(0-t), AUC(0-∞), and Cmax were within 80-125% limits. Adverse events were monitored during the study based on the subject claims and clinical parameters.Twenty-six healthy male and female volunteers (mean age ca. 29 years; body mass index 22.7 kg/m²) were in-cluded in the study, and 24 completed the clinical part. The geometric mean ratios (test/reference) for the log-transformed AUC(0-t), AUC(0-∞), and Cmax were 95.16% (90% CI 92.52-97.87%), 95.08% (90% CI 92.40-97.83%), and 100.00% (90% CI 94.83-105.45%), respectively. There were no significant differences in the pharmacokinetic parameters between the test and reference formulations. No serious adverse events were reported.The results of this single-dose study in healthy Caucasian volunteers indicate that Bisocard®; 2.5 mg film-coated tablets are bioequivalent to the reference product - Concor Cor 2.5®; 2.5 mg film-coated tablets. Both products had similar safety profile and have been well tolerated.

Background Vitamin D is a compound of great importance in controlling the biological functions of the body in a variety of ways. Significance of vitamin D in the pathogenesis and treatment of various diseases has been described repeatedly. One of the most discussed issues in the literature is the importance of vitamin D deficiency in the pathogenesis of hypertension. This relationship is particularly important in patients burdened with elevated cardiovascular risk, which undoubtedly represent patients with diagnosed disease of the cardiovascular system. The aim of the study was to determine the association between the occurrence of vitamin D deficiency and the prevalence of hypertension in premenopausal women at very high cardiovascular risk. Materials and methods The study included 49 women who had previously been diagnosed with cardiovascular disease. In all patients enrolled in the study serum concentrations of vitamin D were measured and the patients were classified to have vitamin D deficiency or normal vitamin D level, based on the existing criteria. The patients were also tested for the occurrence of hypertension. Medical records of all patients were reviewed for early diagnosis of hypertension, and blood pressure measurements were performed on admission to the hospital before the surgery by a qualified physician, in a manner consistent with current guidelines Results The study population was aged 47.7 ± 13.4 years. The mean body mass index was 25.2 kg/m 2 . Vitamin D deficiency was diagnosed in 25 (51%) patients, and hypertension was diagnosed in 30 women (61.2%). In patients with vitamin D deficiency hypertension occurred in 18 (72%) women, while in the group without vitamin D deficiency hypertension was diagnosed in 50% of cases (12 women). The observed difference between the groups was statistically significant (p = 0.049). There was no difference in the incidence of other cardiovascular risk factors between the groups, including the prevalence of dyslipidaemia or nicotine addiction. Conclusion Association of hypertension with the vitamin D deficiency has been repeatedly underlined in many scientific studies. In the present group of patients at very high cardiovascular risk, we confirmed the relationship of vitamin D deficiency with the occurrence of hypertension. Exact confirmation of this issue requires further, largescale research, but this study may suggest the importance of vitamin D supplementation in these patients.

Background Total hip replacement is a common orthopaedic procedure associated with an elevated cardiovascular risk. There are several methods for total hip replacement, including whether or not to use cement for the prosthesis fixation. The aim of the study was to compare clinical characteristics, including blood pressure, in patients undergoing total hip replacement with and without the use of cement. Material and methods The study included patients with elective total hip replacement surgery, who were divided into those in whom the procedure was performed with or without the use of medical cement. The criteria for using cement were assessed during operation by the operator, according to the current protocol. All patients were interviewed, screened, and had their medical records checked for the prior diagnosis of cardiovascular risk factors. Blood pressure values were measured before and after the procedure according to the current guidelines. Results The study population consisted of 65 patients in whom the total hip replacement was performed (mean age 61.5 ± 15.0 years; 50.8% male). 60% of patients had the hip replacement without cement and 40.0% had a procedure with the use of cement. Patients in whom the cement was used were significantly older (75.0 ± 8.5 vs. 53.0 ± 11.5 years; p < 0.0001) and more often diagnosed with arterial hypertension (61.5 vs. 33.3%; p = 0.04), than those in whom it was not used. Systolic blood pressure values were significantly higher before and after the procedure (138.8 ± 18.2 vs. 130.8 ± 21.5 mm Hg, p = 0.04; 122.6 ± 13.3 vs. 113.8 ± 14.1 mm Hg, p = 0.03; respectively) in the group which required cement. Conclusions Patients with hip replacement using cement have higher systolic values before, and after the surgery than in patients in whom cement wasn’t used. Therefore careful management and risk assessment is especially important in patients receiving the total hip replacement with the use of cement.

Introduction. Arterial hypertension is the most frequent modifiable risk factor for cardiovascular disease and premature mortality globally. Availability of novel antihypertensive agents with unique pharmacological characteristics improves the efficacy and safety of antihypertensive therapy. The aim of the ALMONDS survey was to identify the attitude of Polish medical professionals towards novel pharmacological agents used in the therapy of hypertension. In particular, we sought to investigate the views regarding the “class effect” for antihypertensive agents. Material and methods. The study was conducted using a standardized survey, which was filled in by 784 specialists or trainees in cardiology, internal medicine, family medicine, and diabetology. The letter form and anonymity of the survey allowed to maximize the reliability of the collected data. Results. The majority of the study group were females 46-60 years of age. A substantial proportion of the physicians specialized in internal medicine and had more than 20 years of professional experience. The management was mostly guided by the Polish Society of Hypertension (PTNT) guidelines or the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guidelines. In patients with hypertension and coronary artery disease, the most commonly chosen drug treatment included a beta-blocker and an angiotensin-converting enzyme (ACE) inhibitor or an ACE inhibitor and a vasodilating beta-blocker. The latter combination was also selected most frequently in patients with hypertension and heart failure. In women in reproductive age, a vasodilating beta-blocker and a calcium antagonist were selected most frequently, while a combination of nebivolol and zofenopril was indicated as the best in young men with hyperkinetic circulation. In patients with resistant hypertension, the most frequently chosen regimen included furosemide, amlodipine, zofenopril, and nebivolol. Another popular combination included torasemide, lercanidipine, telmisartan, and carvedilol. Conclusions. The results of our study indicate that Polish medical professionals have clear preferences regarding specific pharmacological agents within drug classes. Vasodilating agents are preferred among beta blockers, newer agents among ACE inhibitors, dihydropyridines among calcium antagonists, and loop diuretics among diuretics. This attitude is generally consistent with the 2015 PTNT guidelines.

COVID-19 pandemic changed the current state of healthcare, especially in terms of reorganization of resources. Chief complaints of patients admitted to hospitals changed drastically in the proceeding months, which worsened the treatment of many acute and chronic conditions involving cardiovascular system pathologies and resources were moved in order to fight COVID-19. Moreover, the pandemic had long-term effects not only on healthcare but also national security on global scale. The COVID-19 drastically changed perception of global health and safety, trust in healthcare professionals as well as patients' willingness to seek medical help. The long-term effect of the epidemic, in terms of its impact cardiovascular disease progression and prognosis remain to be observed. The current paper discusses the impact of COVID-19 on healthcare and national security based on the currently available data.

Objective Periprosthetic femur fractures are one of the most severe complications of total hip arthroplasty. Methods The aim of this study was to assess outcomes of periprosthetic femur fractures based on the Vancouver classifications of fractures. Results Sixty-four patients were enrolled into the study. Type B1 fractures were the most common – 33 cases. In comparison to patients with type B3 fracture, patients with type B1 fracture significantly less often experienced postoperative pain. Conclusion Study shown that in the context of both objective outcomes of the operation and patient satisfaction, the most unfavourable prognosis is after type B3.

Background: Assessment of blood pressure values and early diagnosis of hypertension are especially important in high-risk group, including patients in preoperative and postoperative period. The aim of the current study was the assessment of blood pressure values and prevalence of hypertension in patients undergoing elective hip replacement surgery — an orthopedic procedure associated with one of the highest cardiovascular complication rate. Material and methods: Two hundred and eighty-four consecutive patients admitted for elective hip replacement surgery were screened for arterial hypertension. All patients had their medical records reviewed for prior diagnosis and had their blood pressure measured on admission by a qualified physician prior to the procedure, according to the current guidelines. Results: The mean age of the study population was 62.2 ± 13.9 years and 42.7% of the patients were male. The body mass index (BMI) in the study population was 27.0 ± 4.2 kg/m 2 . Fifty-eight point two percent of patients were diagnosed with arterial hypertension previously. Mean blood pressure values on admission for systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 134.5 ± 20.4 and 78.6 ± 13.1 mm Hg, respectively. In 43.2% of patients, the on admission blood pressure values exceeded the threshold of ≥ 140 and/or 90 mm Hg. Arterial hypertension was diagnosed de novo in 33 (15.0%) patients. Patients with the disease were older (67.5 ± 12.3 vs. 54.4 ± 13.9 years; p < 0.0001), and had higher BMI (27.6 ± 4.3 vs. 26.2 ± 3.8 kg/m 2 ; p = 0.05) than patients without the diagnosed disease. Diabetes mellitus was more often found in hypertensive patients (13.3% vs. 3.3%; p = 0.02), they also more often had history of myocardial infarction (p = 0.02), stable coronary artery disease (p = 0.001) and heart failure (p = 0.006) compared to patients without the diagnosis. Conclusions: The majority of patients scheduled for elective hip replacement surgery is diagnosed with arterial hypertension. The disease is also diagnosed de novo in 15% of these patients. Screening for arterial hypertension is important in this group of patients and can potentially reduce the complication rates of the hip replacement surgery.

Background B-type natriuretic peptide (BNP) is a biomarker commonly used in diagnosing and assessing prognosis in heart failure patients. Its concentration can be elevated in various conditions associated with excessive heart wall stretch including atrial fibrillation and obstructive sleep apnoea (OSA). The aim of the study was to assess if BNP levels in atrial fibrillation patients are associated with the value of apnoea-hypopnea index (AHI). Material and methods Study population were consecutive patients with atrial fibrillation, who underwent overnight sleep study, and had blood taken for BNP concentration assessment. Subsequently, patients were divided into group according to AHI: Group I ( 15/h). Results Analysis covered 158 patients (males, 64.6%; mean age, 58.3 ± 9.2 years). 83 (52.5%) patients had AHI 15 (104.0 ± 150.8 pg/mL; p for trend = 0.03). Conclusions Majority of patients with atrial fibrillation have AHI < 5/h and these generally have lower BMI, and neck circumference. Patients who have AHI exceeding ≥ 5/h BNP levels tend to be elevated, and its values rise along with AHI.

Background Arterial hypertension is one of the major cofounders in the development of atrial fibrillation (AF) and hypertension is commonly found in AF patients. The aim of the study was to establish the prevalence of arterial hypertension in patients undergoing ablation, who are relatively young and healthy group of AF patients. Material and methods 266 consecutive patients admitted for AF ablation were screened for arterial hypertension. All patients had their blood pressure measured on admission by, prior to the ablation procedure by a qualified physician, according to the current guidelines. Also, medical records of patients were reviewed for the previous diagnosis of hypertension or taking hypotensive agents. Results The study group was predominantly male (65.0%; mean age 57.6 ± 10.1 years). Mean body mass index was 29.7 ± 5.0 kg/m 2 . Paroxysmal AF was present in 69.5% of patients. In 72.9% of patients hypertension was diagnosed previously. On admission, mean systolic and diastolic blood pressure values were 131.7 ± 16.7 and 80.7 ± 11.1 mm Hg. 123 (46.2%) patients had systolic and/or diastolic blood pressure values respectively > 140 and/or > 90 mm Hg. Patients with previously diagnosed hypertension were older (58.7 ± 8.7 vs 54.6 ± 12.7 years; p = 0.003), had higher BMI (30.3 ± 5.0 vs 28.1 ± 4.8 kg/m 2 ; p = 0.002), and more often history of diabetes (10.8% vs 1.4%; p = 0.03) compared to non-hypertensive group. There were no differences in terms of history of dyslipidaemia, stroke, myocardial infarction or family history of cardiovascular disease. Conclusions In patients with AF undergoing ablation procedure, prevalence of diagnosed arterial hypertension is very high, much higher than in the general population. Nevertheless, majority of patients meet the criteria for adequate blood pressure control.

Background: Erectile dysfunction (ED) is highly prevalent in patients with diseases of cardiovascular system, including patients with atrial fibrillation (AF). Reasons for this high co-prevalence include endothelial dysfunction, inflammation, oxidative and emotional stress associated with AF. Association of AF-induced prothrombotic state and possible microthrombi in penile arteries with ED remains unclear. The present study aims to assess if probability of AF-associated risk of peripheral thromboembolism may be associated with ED in AF patients. Methods: Probability of thromboembolic complications was assessed with two commonly used risk scores CHADS 2 and CHA2DS 2 -VASc in a group of continuous AF patients. All patients were also asked to fill an IIEF-5 questionnaire designed for screening for ED. Results: Mean CHADS 2 score in the whole study group was 1.1 ± 1.0 points and CHA 2 DS 2 - -VASc was 1.5 ± 1.4 points. ED was present in 57.4% of the 129-person study population. In patients with ED, both CHADS 2 (0.9 ± 1.0 vs. 1.3 ± 1.1; p = 0.03) and CHA 2 DS 2 -VASc (1.2 ± 1.1 vs. 1.8 ± 1.5; p = 0.03) scores were significantly higher than in the group without dysfunction. After dividing the patients according to age into groups younger than 65 years vs. ≥ 65 years, observed correlation was no longer significant in the younger group (p > 0.05). In patients ≥ 65 years, in whom the risk scores are routinely used, dysfunction both CHADS 2 (1.1 ± 0.9 vs. 2.0 ± 0.9; p = 0.02) and CHA 2 DS 2 -VASc (2.3 ± 1.1 vs. 3.4 ± 1.3; p = 0.04) scores were higher in the group with ED. Conclusions: Erectile dysfunctions in AF patients are associated with elevated cardioembolic risk. We postulate that the diagnosis of ED should be considered an additional marker of prothrombotic state, and may be useful in clinical decision-making, especially in patients ≥ 65 years old.

Background Prior studies suggested that obstructive sleep apnea (OSA) promotes recurrence of arrhythmia in patients after atrial fibrillation (AF) ablation. Methods In this prospective, long-term, observational study, we enrolled 290 consecutive patients admitted for AF ablation. Prior to the ablation, all patients underwent a polygraphy sleep study for the diagnosis of OSA. After the procedure, patients were followed up for mean time of 30 months for AF reoccurrence. OSA was diagnosed when apnea–hypopnea index (AHI) was ≥5. Patients were subsequently divided into groups according to the OSA severity: mild OSA (AHI 5–15/h), moderate OSA (AHI >15 and ≤30/h), and severe (AHI >30/h). Results After excluding patients disqualified from the procedure, and those with central sleep apnea, the study population consisted of 251 patients, mean age 57.6 years [163 (64.9 %) male]. OSA was present in 115 (45.8 %) patients, while in 137 (54.6 %) cases, we observed reoccurrence of AF. Recurrence was more often in patients with, than without, OSA (65.2 vs. 45.6 %; p = 0.003). We also observed that along with rising OSA severity rose also the number of patients in whom AF was detected during the follow-up period (45.6 vs. 66.2 vs. 57.6 vs. 81.8 %; p = 0.005; for non-OSA, mild, moderate, and severe, respectively). Conclusions OSA is highly prevalent in AF patients. The presence of OSA lowers chances on successful AF ablation. Early screening, and treatment for OSA in AF patients, may improve low success rates of AF ablation procedures.

Background: Various conditions, including arterial hypertension, exhibit seasonal trends in their occurrence and magnitude. Those trends correspond to an interest exhibited in the number of Internet searches for the specific conditions per month. Aim: The aim of the study was to show seasonal trends in the hypertension prevalence in Poland relate to the data from the Google Trends tool. Methods: Internet search engine query data were retrieved from Google Trends from January 2008 to November 2017. Data were calculated as a monthly normalised search volume from the nine-year period. Data was presented for specific geographic regions, including Poland, the United States of America, Australia, and worldwide for the following search terms: “arterial hypertension (pol. nadciśnienie tetnicze)”, “hypertension (pol. nadciśnienie)” and “hypertension medical condition”. Seasonal effects were calculated using regression models and presented graphically. Results: In Poland the search volume is the highest between November and May, while patients exhibit the least interest in arterial hypertension during summer holidays (p < 0.05). Seasonal variations are comparable in the United States of America representing a Northern hemisphere country, while in Australia (Southern hemisphere) they exhibit a contrary trend. Conclusions: In conclusion, arterial hypertension is more likely to occur during winter months, which correlates with increased interest in the search phrase “hypertension” in Google.

Background: Dyslipidaemia, especially elevated low-density lipoprotein cholesterol (LDL-C), is one of the most important cardiovascular risk factors. Treatment of dyslipidaemia and prevention of cardiovascular disease (CVD) with lipid-lowering drugs is one of the key issues in reducing cardiovascular mortality. Nevertheless, underutilisation of statins and lipid-lowering drugs is still a problem globally. Aim: The present study aimed to describe the utilisation of lipid-lowering drugs in groups of patients with indications for statin treatment and elevated LDL-C. Methods: The study included adult patients with an indication for the use of a lipid-lowering therapy, currently using or not using such therapy because of contraindications or statin intolerance, in whom LDL-C concentration was > 70 mg/dL, treated in outpatient settings. All patients were screened for CVD and had blood cholesterol concentration assessed. Patients were also divided into: (1) patients with vascular disease; (2) patients with diabetes mellitus; (3) aged ≥ 65 years; and (4) patients without the three mentioned risk factors. Results: The study group consisted of 2812 (51.4% male) patients. Major cardiovascular risk factors including arterial hyper­tension, type 2 diabetes mellitus, and smoking were highly prevalent in the study population (86.2%, 44.1%, and 23.3%, respectively). Out of the prespecified risk factors (vascular disease, diabetes mellitus, age ≥ 65 years) the study population was divided into patients without any of the mentioned risk factors (n = 520), those with all the three risk factors (n = 368), two out of three risk factors (n = 934), and one risk factor (n = 990). The study showed that 89.6% of patients were treated with statins (47.8% with atorvastatin, 27.8% with rosuvastatin, and 13.8% with simvastatin). Fenofibrate was used in 5.8% of the population and ezetimibe in 2.7%. In the whole group, 7.1% of patients did not receive any type of lipid-lowering therapy. Atorvastatin was more often used in patients with all the three prespecified risk factors, while rosuvastatin was used in patients without any of the risk factors. Conclusions: The most often-used lipid-lowering drugs in Poland are statins, with atorvastatin and rosuvastatin being used the most common of these. The present study shows that some patients with LDL-C concentration > 70 mg/dL and indications for lipid-lowering are not treated accordingly.

Professional drivers are a group exposed to many cardiovascular risk factors. Non-systematic working hours, prolonged stress, low physical activity, along with irregular, and in most cases, unhealthy meals are common aspects of the normal working schedule of most of the professional drivers. These translate into high risk of cardiovascular disease (CVD).The aim of the current analysis was to establish the prevalence of dyslipidaemia in a group of continuous professional drivers.The RACER (Risk of Adverse Cardiovascular Events among professional dRivers in Poland - Ambulatory Blood Pressure Monitoring) study is a prospective study focused on assessing cardiovascular risk factors in professional drivers. Patients included in the study were screened for classical and non-classical cardiovascular risk factors and had an ambulatory blood pressure monitoring (ABPM) performed. Out of the whole RACER study population, 144 drivers were included into the RACER-ABPM study.Out of this group 135 (95.7%) were male, and the mean age was 50.2 ± 9.3 years, and mean body mass index was 32.3 ± 3.0 kg/m². A family history of CVD was noted in 21.3% of patients, 28.1% were current smokers, and 2.9% had diabetes mellitus. Out of those patients, 72.2% had low-density lipoprotein cholesterol (LDL-C) level115 mg/dL, 85.5% had LDL-C100 mg/dL, and 96.7% had LDL-C70 mg/dL. High-density lipoprotein cholesterol40 mg/dL in men and45 mg/dL in women was present in 84.4% of cases. Triglycerides150 mg/dL were found in 28.9% of cases.In conclusion, dyslipidaemia is highly prevalent in professional drivers. Obesity is one of the major contributors to the cardiovascular risk, and dyslipidaemia along with other risk factors highly prevalent in this subgroup accounts for poorer prognosis.